SUPPLEMENTARY MATERIAL

Table of Contents / Page
Supplementary Table 1: Patient and procedure characteristics according to the procedure period
Supplementary Table 2: Adverse outcomes at 30-day according to the procedure period
Supplementary Table 3: Repeat procedures
Supplementary Fig. 1: Study flow and population
Supplementary Fig. 2: Clinical outcomes according to the procedure period
Supplementary Fig. 3: Cardiac rhythm at the time of final follow-up
Supplementary Fig.4:Cumulative incidence of repeat procedures / 2
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Supplementary Table 1: Patient characteristics and procedure characteristics according to procedure years

T1
N=402 / T2
N=402 / T3
N=402 / P value
Age (years) / 63.2±9.7 / 64.7±9.3 / 65.1±9.4 / 0.01
≥75 years / 42 (10.5%) / 51 (12.7%) / 58 (14.4%) / 0.23
Paroxysmal AF / 292 (72.6%) / 294 (73.1%) / 267 (66.4%) / 0.07
Duration of AF History (years) / 2.9 [0.7-7.0] / 2.5 [0.6-5.9] / 1.9 [0.6-5.2] / 0.03
Female / 117 (29.1%) / 120 (30.0%) / 113 (28.1%) / 0.86
History of heart failure / 29 (7.2%) / 34 (8.5%) / 35 (8.7%) / 0.70
Hypertension / 232 (57.7%) / 238 (59.2%) / 237 (59.0%) / 0.90
Diabetes / 67 (16.7%) / 62 (15.4%) / 66 (16.4%) / 0.88
Ischemic stroke / 52 (12.9%) / 36 (9.0%) / 33 (8.2%) / 0.06
Intracranial hemorrhage / 4 (1.0%) / 4 (1.0%) / 3 (0.8%) / 0.91
Vascular disease / 39 (9.7%) / 42 (10.5%) / 36 (9.0%) / 0.77
Hypertrophic cardiomyopathy / 9 (2.2%) / 12 (3.0%) / 15 (3.7%) / 0.46
Dilated cardiomyopathy / 11 (2.7%) / 6 (1.5%) / 2 (0.5%) / 0.03
Post cardiac electronic device implantation / 17 (4.2%) / 12 (3.0%) / 15 (3.7%) / 0.63
Post cardiac surgery / 9 (2.2%) / 7 (1.7%) / 10 (2.5%) / 0.75
CHA2DS2 score / 1.2±1.1 / 1.1±1.0 / 1.2±1.0 / 0.84
CHA2DS2-VASc score / 2.0±1.5 / 2.0±1.5 / 2.0±1.5 / 0.74
≥ 2 / 224 (55.7%) / 242 (60.2%) / 240 (59.7%) / 0.40
Echocardiography
Left ventricular diastolic diameter (mm) / 46.7±6.5 / 45.8±6.1 / 46.5±5.9 / 0.08
>55 mm / 33 (8.3%) / 20 (5.0%) / 24 (6.0%) / 0.16
Left ventricular ejection fraction (%) / 60.2±15.5 / 65.0±10.3 / 64.1±10.8 / <0.001
<50 % / 97 (24.3%) / 26 (6.5%) / 30 (7.5%) / <0.001
Left atrial diameter (mm) / 40.8±7.1 / 40.7±6.6 / 41.2±6.9 / 0.53
>40 mm / 199 (49.6%) / 219 (54.5%) / 226 (56.5%) / 0.13
Medications
Oral anticoagulation / 357 (88.8%) / 380 (94.5%) / 400 (99.5%) / <0.001
Warfarin / 357 (88.8%) / 202 (50.3%) / 77 (19.2%) / <0.001
Dabigatran / 0 (0.0%) / 168 (41.8%) / 144 (35.8%) / <0.001
Rivaroxaban / 0 (0.0%) / 10 (2.5%) / 100 (24.9%) / <0.001
Apixaban / 0 (0.0%) / 0 (0.0%) / 53 (13.2%) / <0.001
Antiplatelet / 121 (30.1%) / 87 (21.6%) / 53 (13.2%) / <0.001
Class I/III AAD / 198 (49.3%) / 115 (28.6%) / 83 (20.7%) / <0.001
ACE-I/ARB / 150 (37.3%) / 171 (42.5%) / 177 (44.0%) / 0.13
Beta blockers / 121 (30.1%) / 118 (29.4%) / 177 (44.0%) / <0.001
Procedure characteristics
PV isolation success / 401 (99.8%) / 401 (99.8%) / 401 (99.8%) / 1.00
Additional ablations
Tricuspid valve isthmus ablation / 368 (91.5%) / 384 (95.5%) / 384 (95.5%) / 0.03
SVC isolation / 114 (28.4%) / 217 (54.0%) / 8 (2.0%) / <0.001
CFAEablation / 54 (13.4%) / 100 (24.9%) / 141 (35.1%) / <0.001
Left atrial roof line / 10 (2.5%) / 11 (2.7%) / 13 (3.2%) / 0.81
Mitral isthmus line / 9 (2.2%) / 11 (2.7%) / 16 (4.0%) / 0.34

AAD=antiarrhythmic drug; ACE-I=angiotensin converting enzyme inhibitor; AF=atrial fibrillation; ARB=angiotensin receptor blocker, ATP=adenosine triphosphate, CFAE=complex fractionated atrial electrogram, PV=pulmonary vein, SVC=suoerior vena cava, T=tertile.

Supplementary Table 2: Adverse outcomes at 30-day according tothe procedure period

T1
N=402 / T2
N=402 / T3
N=402 / P value
Any adverse outcomes at 30-day / 23 (5.7%) / 13 (3.2%) / 8 (2.0%) / 0.02
Death / 0 (0.0%) / 0 (0.0)% / 0 (0.0%) / -
Cardiac tamponade / 10 (2.5%) / 5 (1.2%) / 5 (1.2%) / 0.30
Atrio-esophageal fistula / 1 (0.3%) / 0 (0.0%) / 0 (0.0%) / 0.33
Stroke / 1 (0.3%) / 0 (0.0%) / 0 (0.0%) / 0.33
Systemic embolism / 1 (0.3%) / 1 (0.3%) / 0 (0.0%) / 0.44
Sepsis / 1 (0.1%) / 0 (0.0%) / 1 (0.3%) / 0.30
Pneumothorax / 0 (0.0%) / 0 (0.0%) / 0 (0.0%) / -
Phrenic nerve palsy / 5 (1.2%) / 3 (0.8%) / 1 (0.3%) / 0.23
Gastric motility disturbance / 0 (0.0%) / 2 (0.5%) / 2 (0.5%) / 0.20
Arterio-venous fistula / 2 (0.5%) / 2 (0.5%) / 0 (0.0%) / 0.20
Femoral pseudoaneurysm / 5 (1.2%) / 1 (0.3%) / 1 (0.3%) / 0.12

AF=atrial fibrillation, T=tertile.

Supplementary Table 3: Repeat procedures

Overall
N=1206 / Paroxysmal AF
N=854 / Non-paroxysmal AF
N=352 / P value
N of patients with event/ N of patients at risk (percentage) / N of patients with event/ N of patients at risk (percentage) / N of patients with event/ N of patients at risk (percentage)
Recurrent AT after 1st session / 525/1206 (44%) / 325/853 (38%) / 200/353 (57%) / <0.001
2nd session / 407/525 (78%) / 254/325 (78%) / 153/200 (77%) / 0.66
Recurrent AT after 2nd session / 110/407 (27%) / 51/254 (20%) / 59/153 (39%) / <0.001
3rd session / 39/110 (36%) / 19/51 (37%) / 20/59 (34%) / 0.71
Recurrent AT after 3rd session / 22/39 (56%) / 10/19 (53%) / 12/20 (60%) / 0.64
4th session / 5/22 (23%) / 2/10 (20%) / 3/12 (25%) / 0.59

AF=atrial fibrillation; AT=atrial tachyarrhythmia

Supplementary Fig. 1: Study flow and population

AF=atrial fibrillation, T=tertile.

Supplementary Fig.2: Clinical outcomes according to the procedure period

A) B)

C) D)

E) F)

G)

T=tertile.

Supplementary Fig.3: Cardiac rhythm at the time of final follow-up

Patients without AF/AT are shown in blue, those with paroxysmal AF/AT in pink, and those with fixed AF/AT in red. Left-side barwith AADs and right-side bar without AADs.

AAD=antiarrhythmic drug, AF=atrial fibrillation, AT=atrial tachycardia


Supplementary Fig.4: Cumulative incidence of repeat procedures

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